Joey the hungry quasar, starving grad students, in-house pharmacies, and the true cost of redlining

Issue #5 of American Journalist

1) The Human Health Costs of Redlining

Lots of neighborhoods, including our own, have a shameful history of “redlining”—historically defined according to discriminatory mortgage practices but more broadly including things like covenants in home sale contracts that bar new owners from later selling to Black families, gerrymandered school districts and voting precincts, and neighborhood pools that limit use to exclude renters and neighborhoods with more Black people. These are shameful practices, and some are even worse. Studies in the emerging field of environmental justice have shown that trash dumps, landfills, garbage incinerators, and even toxic waste dumps are much more likely to be found in predominantly Black neighborhoods, including in places like Houston, Texas. This week we saw not just one but three studies on the human health legacy of historic redlining.

Researchers at the University of Colorado Boulder used high-resolution satellite data, air pollution models, historical demographic information, and other techniques to analyze 2019 air quality in the great city of Denver. Specifically, they estimated neighborhood-by-neighborhood levels of nitrogen dioxide and PM_2.5—those fine-sized floaty particles that lodge in your lungs, irritate your airways—and notes of toxic choke to air pollution. Surprise, surprise—they found that concentrations of these pollutants are higher in communities subject to historic redlining. Environmental Science & Technology

In a second paper, researchers at Emory University in Atlanta studied medical and demographic data from 1,764 women with breast cancer and found that historical mortgage discrimination influences modern-day cancer outcomes. Black women who live in historically redlined areas were more likely to be diagnosed with aggressive estrogen receptor–negative breast cancer. White women living in those neighborhoods were more likely to be diagnosed with breast cancer at a later stage of the disease, and (in direct consequence) were more likely to die from breast cancer than white women in other neighborhoods. (Black women in the study were more likely to die of breast cancer regardless of where they lived.)

A map of the Denver metro area with nitrogen dioxide concentrations shown and the racial makeup of different neighborhoods indicated. CC-BY-NC-ND 4.0

A third study, from New York University, followed a group of 162,587 adults in need of a kidney transplant from across the United States for 25 years. It found that Black people who resided in highly segregated neighborhoods were 10 percent less likely to receive a live donor kidney than Black people on the wait list who lived in low-segregation neighborhoods. JAMA Internal Medicine

2) The pharmacy will see you now

The cost of American health care is one of the great unsolved problems of our time. It’s absurd that health care is so expensive in the United States and that so many people in this country face bankruptcy over its cost. A study last year revealed the vast majority of those opting for assisted suicide under Oregon’s 25-year-old law are Medicare/Medicaid recipients, and more than half say they chose to end their lives because of the cost of continuing their treatment.

One of the big drivers of cost, of course, are prescription drugs. An interesting study from Weill Cornell Medical College in New York City this week shows that in the last decade there was substantial growth in the share of Medicare spending on high-cost drugs filled at the doctor’s office as opposed to an outside pharmacy.

Looking at the share of Medicare Part D spending in five medical specialties on drug prescriptions—filled between 2011 and 2019 by 8,020,652 people, age 66–81—the researchers found stunning growth of these so-called in-house pharmacies for high-cost but self-administered drug classes like oral anticancer treatments, antivirals, and immunosuppressants. By 2019, 63 percent of medical oncologists, 20 percent of urologists, 29 percent of infectious disease specialists, 21 percent of gastroenterologists, and 22 percent of rheumatologists were in organizations with specialty in-house pharmacies, a jump of more than double in those specialties.

Why is this concerning? It’s efficient, saving patients time, and the study found that drugs filled in-house were also slightly cheaper. Still, we wonder whether it could create perverse incentives. If doctors receive a cut on any prescription they write, would they be motivated to overprescribe? Or if they receive a larger payout for prescribing a more expensive drug, would they unduly favor it over another cheaper but no less effective medicine? OK let’s just say for the benefit of doubt, perhaps not. But at the very least it suggests the appearance of a conflict of interest. JAMA Network Open

3) A 2,500-year-old DNA sample uncovers an ancient case of Down syndrome

Researchers at the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, screened the DNA of some 10,000 people, which was recovered from ancient skeletal remains found in Ireland, Spain, Bulgaria, and Greece—some more than 5,000 years old. They identified six cases of Down syndrome and one case of a similar condition known as Edwards syndrome (believed to be the first ever discovered in the ancient world). Most died and were buried shortly after birth, and some were given “exceptional” burials and placed into graves with items of significance. For instance, one child, buried more than 2,500 years ago in Early Iron Age Navarra, Spain, was given a lavish burial with bronze rings, a seashell carried from a far-away coastline, and the remains of what researchers said were either three sheep or three goats.

“The care with which the burials were conducted, and the items found with these individuals indicate that ancient societies likely acknowledged [them] as members of their communities, from the perspective of burial practice,” the researchers write. Nature Communications

4) Meet “Joey”—the hungriest object in the universe

Researchers at Australian National University in Canberra have discovered a new quasar, which, as a reminder for many of our fellow biology and English-major friends out there, belongs to a class of objects that are extremely bright and super active. They are not stars but rather super-luminous galactic centers powered by massive black holes lying at their core.

The new quasar has the unfortunate designation “J0529-4351.” (What happened to the day and age when scientists used to give real names to things?) For want of a better name, we are going to call this object “Joey.” There are no pictures of Joey, so we will have to make due with Dall•E.

At the center of Joey is an inordinately huge black hole with a mass estimated to be 17–19 billion times that of our own sun. And as if that’s not enough, it continues to gobble up the equivalent of one sun per day. That’s why I call it the hungriest object in the universe—though I doubt whether that’s literally true. Somewhere out there, no doubt, is an even hungrier quasar with an even more massive center.

5) The myth of the starving graduate student is no myth

Like us, you may have had a friend in graduate school who was an expert at scamming free meals by showing up at campus events to which he was never invited and ripping into the veggie/cheese plates as if he were. This friend had the reputation of almost never buying his own lunch. That amusing recollection alludes to a more serious problem experienced by people at the graduate and postdoctoral levels—many of them are literally starving.

That’s the conclusion of a new study of 1,745 grad students and postdocs at Harvard University. It showed that 17 percent of graduate students and 13 percent of postdoctoral trainees experienced food insecurity during the previous academic year. “These findings suggest that national and institutional interventions are needed to address the complex, structural factors related to food insecurity among graduate student and postdoctoral trainee populations,” the researchers note. JAMA Network Open

Here is an idea for an intervention: Provide grad students and postdocs with free meals or pay them a higher salary!

6) Want to preserve biodiversity in your food choices?

A somewhat surprising study out of the National University of Singapore looked at 151 popular dishes in the world and ranked them according to their impact on biodiversity. There were a few to-be-expected outcomes, like the fact that many of the most impactful dishes that threaten biodiversity are beef, chicken, or pork dishes. Brazilian steak alone accounted for three of the top-20 largest-biodiversity-footprint dishes (picanha, churrasco, and fraldinha).

What was more surprising, however, was the fact that there were also vegan and vegetarian dishes on the list, including dal lentils, chana masala chickpea stew, and rajma, a curry made with kidney beans. Why would beans and rice be on the same list as dishes that come from animals the raising of which caused large areas of old-growth Amazon rainforest to be clear-cut? The reason, according to the researchers, is that legumes and rice are grown industrially in many places, including in India, and industrial farming may have especially high impacts on threatened species and biodiversity. PLOS ONE